Heated Tobacco Product Use and Lower Physical Activity Among Japanese Adults With and Without Respiratory Diseases: Findings From the JACSIS Study

Physical inactivity contributes to adverse health outcomes and is particularly detrimental in respiratory diseases. Despite being promoted as safer cigarette alternatives, the behavioural effects of heated tobacco products (HTPs) on physical activity remain unclear. This study examined the association between HTP use and physical activity among Japanese adults, particularly those with respiratory diseases.

A cross-sectional study used data from the 2023 Japan COVID-19 and Society Internet Survey (JACSIS), including 28,353 participants aged ≥ 15 years. Tobacco use was classified as never, current, or former use of cigarettes and/or HTPs. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) and expressed in MET-min/week. Multivariable analyses applied analysis of covariance (ANCOVA) and logistic regression comparing low versus moderate/high physical activity, adjusting for demographic, behavioural, and health factors.

Predicted means of physical activity from the ANCOVA model were 1100.9 for never smokers, 1006.8 for cigarette smokers, and 945.6 MET-min/week for HTP users. Current cigarette smokers (β = -94.1 [95% CI: -176.7 to -11.5], p = 0.026) and current HTP users (β = -155.3 [95% CI: -252.7 to -57.9], p = 0.002) exhibited significantly lower physical activity than never smokers. Sensitivity analyses using log-transformed IPAQ scores and logistic regression confirmed these findings. Subgroup analyses indicated reduced activity among HTP users with asthma, but no clear pattern for COPD.

Cigarette smoking and HTP use were associated with lower physical activity, independent of confounders. Smoking cessation, particularly in asthma, should be prioritized, alongside promoting physical activity among tobacco users.